Club/affiliated association delegate registration form

Please note that the form is valid only for the registration of affiliated club/association delegates attending the ACM on 17 September 2022. It must only be completed and submitted by the secretary of the designated club.

If you hold a KCASA role/position, you may be eligible to vote in your own right.

First name:

Surname:

Email address:

Swim England membership number:

Role:

Club/Association and number of delegates:

The number of delegates is based on your club's current Swim England online membership as at 16 August 2022. To verify the eligibility of your delegate(s) to vote on behalf of your club/association at the ACM on 17 September 2022, complete the information below. Please note that any delegates above the number listed in brackets against your club's name will be able to attend but will not be eligible to vote.

Please make sure that Swim England membership numbers and email addresses are correct. Membership numbers will be used to check each delegate's right to vote, and email addresses will be used to send out any additional information immediately prior to the event.

Delegate 1

Forename:

Surname:

Swim England membership number:

Email address:

Delegate 2

Forename:

Surname:

Swim England membership number:

Email address:

Delegate 3

Forename:

Surname:

Swim England membership number:

Email address:

Please note that clicking the 'submit' button confirms that the information above complies with the conditions identified in this form, and that all details have been checked and are accurate.

Human check:

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